Some people are bending the rules on vaccines. Is it safe?

What experts say about risks and whether it’s a real issue

Jordan H. could hardly wait to get a COVID-19 vaccination when several vaccines gained emergency use authorization. His wife, a teacher, was prioritized. While he waited to be eligible, the 39-year-old Provo dad read everything he could about the vaccines.

When his turn came, he chose a place carrying the Johnson & Johnson vaccine — not because it was a single dose, he said, but because it tested well in South Africa where a new COVID-19 variant was circulating. He figured doing well against variants was important for the future.

A COVID-19 vaccination is given at Utah Valley University in Orem on Thursday, Aug. 26, 2021.
A COVID-19 vaccination is given at Utah Valley University in Orem on Thursday, Aug. 26, 2021. | Jeffrey D. Allred, Deseret News

Fast forward six months and Jordan again stood in line for a COVID-19 vaccination. This time, he wanted — and found — the Pfizer-BioNTech vaccine. He had trusted health experts who said it didn’t really matter which vaccine you got, but later news reports made him wonder if that was true.

“Things started trickling out about other variants, and then I learned there were concerns over the effectiveness of the J&J vaccine in comparison to other available vaccines,” he told the Deseret News. “I’m almost 40 and healthy, but I have asthma. I am becoming aware that I am not invincible.”

He’d gotten his first shot at a grocery store. He went elsewhere for the other brand of vaccine. Since he didn’t want to lie, he told an employee he’d lost his vaccine card, but also was switching brands. The individual simply handed him a new card and recorded his “first” shot.

Jordan is among a growing number of Americans trying to pick through information from myriad sources on COVID-19 vaccines — some of it contradictory — to figure out how best to protect themselves and their families as research continues into the need for additional doses of the medication. Because vaccines are a contentious topic, he asked that his last name and occupation not be used.

Recent reports suggest some folks are trying to get a second type of vaccine, as he did. Others are jumping ahead of what may be a forthcoming recommendation from public health officials to get a vaccine booster around the eight-month mark — something the Biden administration supports and hopes regulators will approve.

Some think getting two different vaccine brands could be extra protective. Others are reportedly trying to replace a J&J shot. Like Jordan, they worry the vaccine’s efficacy is lower than either Pfizer’s or Moderna’s for preventing infection and hospitalization.

While Jordan used his real name and was upfront about seeking a different brand of vaccine, authorities believe there are others who are not being truthful in order to jump the line or cross brands. They are taking advantage of the fact a booster is already endorsed for those with immune-compromising conditions like solid organ transplant or cancer. To get the booster, others would have to go to a clinic or pharmacy and lie if they’re asked whether they qualify.

Some nursing homes are providing a third shot to those who want one, saying older people are especially vulnerable and their immune systems probably have weakened over time.

But while it’s reportedly not difficult to get a booster, the jury is still out on whether it’s a good idea?

Other priorities

Audrey Stevenson, director of Salt Lake County Health Department’s Division of Family Health, has heard rumors of people trying to game the vaccination system, but hasn’t seen direct evidence. She thinks most people are following advice from public health experts. Cases she’s heard of about people crossing brands are mostly anecdotal from the media, she said.

Questions about health risks or benefits of an extra vaccine or changing brands have not been settled yet. Stevenson thinks most people have been patient — and also curious if studies would settle questions like whether a booster vaccine is needed and the best timing.

She said public health workers are still concentrating on trying to get individuals to have their initial vaccine. “But we do notice at our outreach events that people show a preference for which vaccine they want.”

More is known about safety and efficacy of individual vaccines as they were designed to be used, though speculation and some small studies have considered variations. For example, Moderna is testing whether its COVID-19 vaccine and a flu shot can be combined into one shot.

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The recommendation from public health experts including the Centers for Disease Control and Prevention and the World Health Organization is to stick with one COVID vaccine brand, Stevenson said, and that’s the rule for those authorized to provide vaccines. “As long as the initial product used is known — and it should be on the vaccination card or in the vaccination registry — we should be able to give them the same one.”

Skipping ahead

Without regulatory approval, getting an early booster for most folks requires misrepresentation. People are asked if they are immune-compromised. They aren’t asked for details. Stevenson said she hasn’t heard of a vaccinator turning someone away because they doubt the answer.

Officials deemed vaccination so important they didn’t require ID. They don’t want to discourage those who don’t have one or who are reluctant to show one.

Even if a doctor wrote a prescription for that kind of “off-label” vaccine use — a term that describes prescribing medicine outside of its usage guidelines, such as a brand cross-over dose or as a booster for someone who’s not immune-compromised — the vaccinator is supposed to say no. Stevenson said vaccinators are constrained by federal guidelines.

Within 24 hours, COVID-19 vaccinations are supposed to be entered in the vaccination registry, a database that tracks immunizations like those required to attend school, among others. At least initially, providers were so swamped and the pandemic process so new some entries lagged.

Among other reasons, the registry matters as a way to verify status if someone loses the vaccination card. That may become more important if employers require workers to show proof of vaccination under a new presidential mandate. The registry could help ensure timing between doses is correct. It could potentially show someone changed vaccinations — or if a provider checked, stop it from happening.

More to learn

Experts say it’s hard to get a head-to-head comparison because effectiveness tests used different end points. Pfizer and Moderna both use mRNA technology and their vaccines test in the mid-90% range for effectiveness in preventing symptomatic illness. But those numbers weren’t generated while variants were circulating. J&J is deemed around 66% effective against moderate to severe infections and 85% against more severe, including against at least some variants. It was developed using different technology, too.

Less is known about J&J because it rolled out after Pfizer and Moderna. But studies of all the vaccines are ongoing.

The Associated Press reported “J&J has presented lab data on virus-fighting antibodies that indicates its vaccine protects against the delta variant for eight months and counting. Another small lab study has raised questions about whether a two-dose approach would work better, an option J&J is studying.”

There are other vaccine-related questions with contradictory early answers. The science is not settled, experts say, on how long natural immunity lasts for those who contracted COVID-19 earlier — or whether it is the same in everyone. There is evidence it wanes. Among questions being studied are whether a single dose of one of the vaccines is adequate for those who have some natural immunity. A study in Israel suggested that having survived COVID-19 is better protection than the vaccines. Other research disagrees.

“Giving a single shot of the vaccine to those who had been previously infected appeared to boost their protection. The long-term benefit of a booster dose of inoculation, which has just recently begun in Israel, is unknown. The data was posted as a preprint article on medRxiv, and hasn’t yet been reviewed by other researchers,” Bloomberg reported.

That study also raised questions about degrees of immunity depending on variants.

Advisers to the Food and Drug Administration are meeting Friday to discuss whether an additional shot should be recommended to boost the Pfizer vaccine. That’s the only one with full FDA approval at this time, though only for those 16 and up. It has emergency use authorization for those age 12-15 and is being studied in younger children.

An international panel of scientists that included researchers from both the FDA and the World Health Organization published a review this week in the medical journal Lancet of all related published studies and clinical trials. They conclude the general population does not need a booster dose right now.

“Taken as a whole, the currently available studies do not provide credible evidence of substantially declining protection against severe disease, which is the primary goal of vaccination,” said lead author Ana-Maria Henao-Restrepo, of WHO, in a press release on the journal article.

“Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society,” she said. “These high-stakes decisions should be based on robust evidence and international scientific discussion.”

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The panel said if COVID-19 vaccine boosters are needed, the flu shot would probably inform the design. That vaccine formula changes to target flu variants expected to circulate during the year. Similarly, COVID-19 boosters would likely be tailored to circulating variants.

Jordan had no complications from getting a second type of vaccine and completed the Pfizer two-shot series. He used his real name. And he imagines he might be listed in the immunization database as being double-covered, but he feels good about his decision.

“It looks to me like I had a booster,” he said.

He believes in vaccines and thinks COVID-19 vaccines “sound like some of the safest ever.” He gets a flu shot annually and said he will follow future recommendations regarding COVID-19 vaccination. He just stopped trusting one vaccine. He also figures he probably faces less danger from the vaccines than from the amount of additives in the foods he consumes every year.

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